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NPI Code Detail

MEDICARE: KAMALJIT PURI M.D.

MEDICARE: KAMALJIT PURI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician54230WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00863259OTHERWIRR MEDICARE

General Provider Information

NPI Number : 1780622787
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAMALJIT PURI M.D.
Provider Business Mailing Address
First Line : 3003 W GOOD HOPE RD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53209-2042
Country : US
Telephone Number : 414-352-3100
Fax Number :
Provider Business Practice Location Address
First Line : N84W16889 MENOMONEE AVE
Second Line :
City : MENOMONEE FALLS
State : WI
Zip : 53051-2810
Country : US
Telephone Number : 262-251-7500
Fax Number : 262-251-7128
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 11/23/2020

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